Well over 50% of people with Down’s syndrome have significant hearing impairment which may be mild, moderate, severe or profound. Sensorineural and/or conductive loss may be present at any age.Hearing impairment can be successfully managed in this population.If undetected it is likely to be a significant cause of preventable secondary handicap.Lifelong audiological surveillance is essential for all. The main cause of conductive loss is persistent otitis media with effusion (OME, glue ear). The natural history of OME and response to intervention differ from that in the general population hence local surveillance and management protocols need to be set up specific to people with Down’s syndrome.